Provider Demographics
NPI:1053512525
Name:SCHMITZ, MARTHA (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 HILLEGASS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1236
Mailing Address - Country:US
Mailing Address - Phone:510-919-1419
Mailing Address - Fax:
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 340 D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-595-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical